摘要
[目的]探讨高位脱位型髋关节发育不良继发骨关节炎的患者,应用短颈直柄型股骨假体进行人工全髋置换的临床体会。[方法]2002年6月～2007年10月,对11例(12髋)高位脱位型髋关节发育不良继发骨关节炎的患者,应用短颈直柄型股骨假体实施人工全髋关节置换术。所有患者均为女性,平均年龄51(41～68)岁。手术采用髋关节后外侧入路,髋臼重建于真正的髋臼窝,根据宿主骨对臼杯的包容情况予以结构性自体植骨;股骨侧应用短颈直柄型假体,骨水泥固定。术中进行广泛的软组织松解。[结果]本组病例患髋旋转中心较术前平均下降4.5(3.8～4.8)cm,患肢平均延长3.9(3.6～4.3)cm。术后平均随访36(10～66`)个月,所有结构性植骨均获得愈合,患髋未出现假体松动,股骨假体的骨-水泥界面及假体-水泥界面均未见透亮线。术后均未出现坐骨神经、股神经麻痹。Harris评分由术前的平均41.8分提高到术后的平均86.2分。[结论]对于术前计划髋关节旋转中心下移不超过5cm的高位脱位型髋关节发育不良继发骨关节炎患者,应用短颈直柄型股骨假体进行人工全髋置换,避免了股骨截骨短缩和大转子截骨,近期效果满意。
[Objective] To evaluate clinical effect of total hip arthroplasty（THA）with a short-neck and straight stem in patients with osteoarthritis secondary to developmental dysplastic hip with high dislocation.[Methods]From June 2002 to October 2007,total hip arthroplasties with a short-neck and straight stem were performed for 11 patients（12 hips）with osteoarthritis secondary to developmental dysplastic hip with high dislocation.All were females with an average age of 51 years（range from 41 to 68 years）.The operations were performed through a posterolateral approach.All the acetabular cups were reconstructed at the original anatomic location,and structural autogenous bone-grafting was performed if the cup was not covered enough by host bone.Short-neck and straight femoral stems were used with cement fixation.During operation,the soft tissue around hip was released extensively.[Results]After surgery,the center of the hip had an average distal translation of 4.5cm（range from 3.8 to 4.8 cm）and the limb length had an average increase of 3.9cm（range from 3.6 to 4.3 cm）.All the patients were followed up for a mean time of 36 months（range from 10 to 66 months）.All structural autografts united and none of acetabular and femoral components showed loosening.No radiolucent line was observed at the bone-cement and at the implant-cement interface around femoral stem.No patient had sciatic or femoral nerve palsy.The mean Harris score increased from preoperative 41.8 points to postoperative 86.2 points.[Conclusion]THA with a short-neck and straight stem for treatment of osteoarthritis secondary to developmental dysplastic hip with high dislocation avoids femoral shortening osteotomy and greater trochanter osteotomy when the center of hip had a distal translation less than 5cm in preoperative plan,and this choice provides satisfactory results at early-term follow-up.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2010年第5期377-380,共4页
Orthopedic Journal of China
关键词
髋脱位
先天性
关节成形术
置换
髋
人工关节
hip dislocation
congenital
arthroplasty
replacement
hip
artificial joint
